急性腹泻婴幼儿胃肠道病毒感染现状与临床特征分析

Distribution and clinical features of gastrointestinal virus infection in infants with acute diarrhea

目的 了解浙江省宁波市北仑区婴幼儿急性腹泻的临床特征及其胃肠道病毒的感染情况。方法 选择2012年7月至2013年7月在北仑区人民医院儿科门诊的900例急性腹泻婴幼儿病例(≤5岁),分析婴幼儿急性腹泻的临床特征并采集粪便样本,用PCR方法检测A/B/C型轮状病毒(Rotavirus,RV)、肠道腺病毒(Enteric adenovirus,AdV)、星状病毒(Astrovirus,AstV)、札如病毒(Sapovirus,SV)及诺如病毒(Norovirus,NV),并采用x2检验对不同性别和年龄段患者病毒检出情况进行比较。结果 900份腹泻患儿粪便样本中369份呈阳性结果,其中单一病毒感染的291份,混合病毒感染78份。在单一病毒感染病例的样本中,NV检出率为19.4％(GⅠ型为4.9％,GⅡ型14.6％),RV-A为8.2％,未检出B型及C型RV,SV为2.9％,AstV为1.0％,AdV为0.8％。在混合感染病例的样本中,以RV-A与NV混合感染最多,为5.8％。2岁以下(含2岁)患儿的病毒总检出率(51.0％)显著高于＞2 ～5岁的患儿(22.1％,x2=70.404,P＜0.01)。369例病毒检测阳性的患儿中,24.1％伴有发热,35.2％伴有呕吐症状。单一病毒感染病例发热、呕吐以及发热合并呕吐的发生率均低于混合感染病例(x2=17.878,21.869和14.155,P＜0.01)。结论 NV和RV-A是浙江省宁波市北仑区婴幼儿急性腹泻的主要胃肠道病毒,2岁以下婴幼儿是这两种病毒的易感人群。

Objective To analyze the distribution and clinical characteristics of gastrointestinal virus infection in infants with acute diarrhea.Methods Stool samples and clinical data were collected from 900 infants (≤5 years old) with acute diarrhea in outpatient department of Beilun District People' s Hospital during July 2012 and July 2013.Specimens were tested for 5 gastrointestinal virus including group A/B/C rotavirus (RV),adenovirus (AdV),astrovirus (AstV),sapovirus (SV) and norovirus (NV) by the multiplex PCR assay.Chi-square test was performed to compare the positive rates of virus infection among children with different genders and ages.Results Among 900 stool samples,369 were positive of gastrointestinal virus,of which 291 were positive for single virus and 78 for mixed virus.In single virus infection,NV was detected with the highest positive rate of 19.4％ (4.9％ for G Ⅰ and 14.6％ for G Ⅱ),followed by RV-A (8.2％),SV (2.9％),AstV (1.0％) and AdV (0.8％).RV-B and C type were not found.In 78 cases with mixed infections,RV-A plus NV infection was the most common one with a prevalent rate of 5.8％.The positive rate in age group ≤2 years old was 51.0％,which was significantly higher than that of age group ＞ 2-5 years old (22.1％,x2 =70.404,P ＜ 0.01).In 369 children with positive gastrointestinal virus,fever was present in 24.1％,and vomit in 35.2％ of children.Fever,vomit and fever plus vomit was more common symptoms in children with mixed infections (x2 =17.878,21.869 and 14.155,P ＜ 0.01).Conclusion NV and RV-A are the most common pathogens in infants with acute diarrhea in Beilun district,especially in children younger than 2 years old.